Experts question 'complete the course' antibiotics advice

The Irish College of General Practitioners has warned patients to always follow their doctor's advice

Experts question 'complete the course' antibiotics advice

File photo: Drugs in a pharmacy. Image: Julien Behal/PA Wire/PA Images

A team of British experts has warned that traditional advice telling patients to always complete the full course of prescribed antibiotics should be dropped.

A controversial new article, published in the British Medical Journal yesterday, has warned that the 'complete the course' guideline could be doing more harm than good.

For decades GPs have urged patients to finish the entire packet - even after their symptoms have gone away.

However a British team led by two top infectious disease experts has claimed there is little scientific evidence to back up the advice – and has warned that the standard advice could be driving human resistance to the medicine.

However, family doctors have voiced their concern that the conflicting advice could leave patients confused.

This morning, a leading Irish antibiotics expert has warned that the article was targeted at the medical profession not patients.

Dr Nuala O'Connor of the Irish College of General Practitioners said patients should always follow the advice of their doctor.

“The message that was interpreted in the newspapers [this morning] was that you should stop antibiotics once you feel better and I think that is incorrect and that would be misleading to patients,” she said.

“What it is is that you should take the course of antibiotics as prescribed and that doctors need to be careful that they only prescribe the necessary course of antibiotics for a particular patient for a particular condition.”

The article, led by Professor Martin Llewelyn of the Brighton and Sussex Medical School, claims that in many cases stopping antibiotics as soon as possible is a safe and effective way to reduce overuse.

The researchers pointed to some notable exceptions – such as those used to treat tuberculosis.

They called for further research to find the most appropriate alternative messages to provide to patients – including telling them to stop when they feel better.

Responding to the article, Dr Dilip Nathwani, chair of the European Study Group on Antibiotic Policies said he was unable to support the call to drop the traditional ‘complete the course’ advice but would be “open to further debate.”

“The evidence they offer in support of their call is sparse and their advice is potentially very confusing for patients,” he said.

“Much clearer evidence and advice are needed before changes in policy are considered, as are further studies to assess the harm that stopping antibiotics early might cause patients, particularly those in high risk or vulnerable groups such as the very young, elderly and those unable for whatever reason to make decisions about their treatment options.”

He said the suggestion that patient s should stop when they feel better is “too subjective” adding that in the best case it will lead to patients stockpiling the medicine for future use without medical advice.

Furthermore he warned that inappropriate antibiotic use will “almost certainly contribute to a rise in antibiotic resistance rates.” 

“The decision to end antibiotic treatment early should be a clinical decision,” he said.

Professor Helen Stokes-Lampard of the British Royal College of GPs said the article was “an interesting editorial” but warned nothing has changed in terms of the antibiotics that will be prescribed or how long you should take them for.